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Home My WebLink AboutBuilding Permit #427-13 - 707 JOHNSON STREET 11/28/2012 �17Z7'P. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ( Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION o ?_ �Cl/�t - Print PROPERTY OWNERlf Print 100 Year Old Structure yeso MAP NO:i PARCELIy ZONING DISTRICT: __ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair a lacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District EJ Water/Sewer DE CRIPTION OF WORK TO BE PERFORMED: w 1-, -1 I' l .t ar Idgntification Please Type or Print Clearly) OWNER: Name: �}nr� (_C \Ai \-A AC, Phone: �1 Z5? -3ly'�ysy Address: l�S� CONTRACTOR Name: c, W, Phone: Address: -7 �/ o73g 115 / �- t � � s� Supervisor's Construction License: 1' 6 Exp. Date: �T IKzl;�_o l Home Improvement License: Ll 0 5 Exp. Date: 1113 / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ c� S ;-�-L-L/ / FEE: $ Check No.: R Qie"40_.�� NOTE: Persons contracting with unregistered cont ors do not nue-access-to-thr-guarantpf-�r;i1- --. ;Signature^of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Ce ed of Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ , Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature f COMMENTS y Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW'I owr-Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at U4 Main Street Fire Departinent signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ® Notified for pickup - Date i Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building pp Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑. Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2012 Location /l/ T �( tio a, r! — No. Date • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee a Foundation Permit Fee $ ' rte " Other Permit Fee $ TOTAL A $ Check, , 6 25987 Building n 6U3'y9 -! :y� Highest Quality Windows' rCw"A` 1-800-693-1307 7 Rolling Hill Avenue , Fed ID 20-0124453 Plaistow, NH 03865 MA License 140588 Name `l1/°'1,Sf f�/y1 Phone# 7�,�" � 3yS Work# Address 77)1r} S�^, f�t City State_ ;�' Zip c2Jyam_ 1/we,the o n�i ers of the premises described above,hereinafter referred to as"purchaser"offer to contract Seacoast Replacement'Windows,to deliver and arrange for installation of all materials to improve the premises. Not Included Included Obtain all insurances and permits ❑ Re-measure all openings to ensure a custom fit ❑ Remove existing windows and install&_vinyl windows. Total new windows / ❑ Wrap outside jam .4 ❑ Remove existing windows and install a new vinyl bay,or bow with all new unpainted,unstained interior casing and appropriate trim on the outside # Install and shingle a custom made roof to fit bay or bow if no overhang exists within 18" Al Remove existing windows and install a new vinyl garden window with the interior casing and exterior wood trim # Cleanup of all job related debris __ ,, ❑ Issue manufacturers limited warranty ❑ Special work—MA-114 t / Ki ! C Gn! /� �'' r�✓t Contract price 7 _Deposit Balance (Due b or upon completion) If this is a credit transaction,the agreement for credit is contained on a separate document. All home improvement contractors and subcontractors shall be registered and that any inquires about a contractor or subcontractor relating to a registration should be directed to:Director,Home Improvement Contractor Registration,PO Box 871,Taunton,MA 02780-0871 508-821-9375 I/We the undersigning are hereby authorizing Seacoast Replacement Windows to verify and review my/our credit record with an independent credit reporting agency and release them from all liability incurred from inadvertent omissions or errors. Verbal understandings and agreements with representatives shall not be binding. All understandings and agreements must be set forth in writing in this contract or on an attached addendum. Gf Work will begin in approximately p to / weeks. You the purchaser may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. All warranties on the owner's rights under the provisions of 780 CMR R6 and MGL c 142A Purchaser understands and agrees that if this arrangement is cancelled after measurements have been made and production cannot be cancelled,complete deposit is forfeited. If production can be halted,a$100.00 measurement fee will be withheld. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signed .� Date d /7 /Z- Signed4 Date Q r ( ?,esentative �' Signed Date Purchaser(s) C10RTH own of _ ndover 0 No. Z , _ 1 h ver, Mass, L A— COC NICNewick 7d AOR'AITE0 S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT rldM ~r` BUILDING INSPECTOR ........... ......... .... .�........................................................... .... Foundation has permission to erect.......... .............. buildings on ...jon�........J%�#V.Iwnt...... .! Rough to be occupied as ........... ............ � � ... ....... ................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough loot VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 6)6 UNLESS CONSTRU ON AR Rough Service ............ ......... ................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): 15�61 K17 G Address: i��f�"�— 11 AUH 03 �6� City/State/Zip: f/0 iS M^/ jV f f C341 Phone#: 6' - V 5)� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2 I am a sole proprietor or partner- listed on the attached sheet.1 ?• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other kny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. tsurance Company Name: :)licy#or Self-ins.Lie.#: Expiration Date: ob Site Address: City/State/Zip: ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a -ie up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification. to hereby certify under the pains and penalties of perjury that the information provided above is true and correct. nature: Date: I lone#: 6 6 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license.number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 evised 5-26-OS www.maq,;.anv/dia 91te &mmvwa4eaa Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massacusetts 02116 Home Improvement Contractor Registration Registration: 140588 Type: Partnership Vol, Expiration: 11/3/2013 Tr# 218874 SEACOAST REPLACEMENT WINDOI/VS r " J JOHN SULLIVAN _ . -- ! 7 ROLLING HILL AVE PLAISTOW, NH 03865 ` �< j a `r `Update Address and return card.Mark reason for change. Address Renewal F] Employment ❑ Lost Card DPS-CA1 %r SOM-04/04-G�7j0//1216pQ //f�' �/� //-- ,fie ✓fte U/O%?9/I720I2CIJP�LGfL 0��CLC1LCGdP.�6 , Office of Consumer Affairs&Business Regulation License or registration valid for individul use only _ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: R Registration:,- X40588 Type: Office of Consumer Affairs and Business Regulation Expiration:.,=1113/.2013 Partnership 10 Park Plaza-Suite 5170 Boston,MA 02116 SEACOAST REP CEMENT,WIN OWS JOHN SULLIVAN +< == 7 ROLLING HILL AVE `=Y_ '.--'` 4 PLAISTOW, NH03865`>> Undersecretar 1 Y� y 6'Not valid without signature Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen icor Special" License: CSSL-099976 JOHN F SULLIAN - 361 CHESTER STREET CHESTER� 03'0'3'6 m Iy Expiration Commissioner 11/16/2013